Question

[Lauren-1998]

Can endo specialist remove moderate endo from the POD by a rectal shave or does a bowel surgeon have to be involved? X

[jjeemm]

Hi Lauren-1998

I've been told that most endo specialists prefer to do a rectal shave, rather than putting patients through a bowel resection if at all possible (sometimes a resection is necessary, but it only happens quite rarely from what I've read and been told and it's only necessary in the most severe cases, so it shouldn't happen if you have moderate endo). However, there should usually be a colo-rectal surgeon to assist with any kind of surgery that involves the bowel. I believe this is standard procedure to ensure the bowel doesn't get damaged in any way. It's also important to have a colo-rectal expert on hand to assess the health of the bowel which can't always be determined beforehand simply via a diagnostic lap, MRI scan or colonoscopy, etc....sometimes the endo damage to the bowel is more extensive than was initially thought and the only way to detect this is during the surgery itself.

Hope this answers your question.

Take care, xx

[Lauren-1998 in reply to jjeemm]

Thanks for your response I had surgery in July last year and I am just concerned that it was not all removed. X

[jjeemm in reply to Lauren-1998]

Hi Lauren

I can totally sympathise. The consultant in my local BSGE Centre has told me that he wants to do a bowel shave, but according to another guy I saw privately, I really need a resection to ensure that no endo tissue is left behind. While I don't want to have a resection for obvious reasons, I just can't see the point of merely shaving off the 'visible' tissue and being left with residual endo which might well grow back again! So I tend to agree with the more 'drastic' approach, even though it all sounds pretty horrendous. For the time being I've actually decided not to opt for any surgery at all (I've also been told I'll need a total abdominal hysterectomy and vagina resection at the same time as the bowel resection!) - instead I'm trying to 'treat' myself through diet and supplements which I must say has done wonders for me so far (touch wood!!).

If you think you may still have some endo left, could you request to have an MRI scan? In my case the MRI revealed much more than the diagnostic lap where nothing much could be seen because everything was 'obliterated' by adhesions and endo tissue.

I really hope the endo hasn't resurfaced after everything you've been through so far...but certainly, yes, no harm in requesting the MRI.

Wishing you the very best of luck going forward, xx

[skygreen in reply to jjeemm]

What is the diet that you have switched to? I’m trying to be gluten free and vegan as much as possible but only 3 weeks in...

[jjeemm in reply to skygreen]

Hi skygreen

Yes, first off, it does take time and dedication before you see any visible improvements - for me it took about 3 months - so please keep on persevering with the diet. As I said, I feel so much better for making the changes.

I'm pretty much the same as you: gluten-free (although I hardly eat any gluten-free bread, but do I have a gluten-free pasta dish once a week on average), dairy-free and pretty much egg-free. I've also given up coffee in favour of one cup of green tea a day and plenty of other herbal teas. I'm also alcohol-free, soy-free and sugar-free (the only 'sweet' things I eat are fresh fruit and the occasional piece of dried fruit...but I don't really eat 'desserts' at all now). Giving up refined sugar really has made a huge difference I feel. I also make sure I only use organic, cold-pressed oils in my cooking (I've read lots of bad things about processed veg oils which I used to cook with all the time). I also get a delivery of organic fruit and veg every week and when I go to the supermarket I try to buy organic as much as possible (more expensive I know 😒). I also drink filtered water and avoid all plastic storage jars and bottles. I do eat fish about once a week - I've read that wild fish like salmon is very good because it contains a lot of Omega 3. I don't eat any meat though - I haven't eaten it for about 30 or so years now. I'm also avoiding any 'white' bleached products like white rice and white cornflour, etc.

I also have a lot of turmeric, ginger and cumin because they're supposed to be anti-inflammatory.

Although it does take time, I'm cooking absolutely everything from scratch...no more ready-meals which I used to have about once or twice a week.

I'm also taking quite a lot of supplements and finding magnesium citrate is especially helpful to ensure regular bowel motility. I'm also taking resveratrol and pycnogenol because they're supposed be beneficial for inflammatory conditions. I'm also taking various other minerals, etc.

The best thing about the diet I've found is that it's made me feel more 'in control' of my condition and has made me hopeful that if I continue with my new regime I may well avoid having to go under the surgeon's knife...huge motivation to keep on going!!

Wishing you all the best with the diet - hang on in there - I'm sure you'll see some improvements to your health soon!

Take good care, xx

[Starry]

It is definitely possible to remove moderate and even severe endo with a rectal shave, depending on the skill of the specialist surgeon, the depth the Endo has infiltrated, it's size and position, and how friable the bowel wall has become. Often that can only be established in surgery itself as scans don't always give a full picture.

Was your surgeon bsge accredited? Bsge surgeons have to do additional lap skills training and handle a minimum number of cases to be accredited. A bowel surgeon is always included in the surgery team for safety reasons, but do ask. My surgery was done jointly between the two surgeons as a team.

I had severe stage 4 rv endo nodule. I was told they would try to shave but that a disc or segment resection and even stoma might well be necessary. I ended up with what he called a 'very deep' bowel shave to remove my 3.5cm nodule and luckily my bowel wall held up. Both the surgeons and I have confidence that it was all removed. This was with a bsge surgical team but private.

Hope this helps.

[Starry in reply to Starry]

I read a lot about recurrence as I could not help but worry too. This was a good overview of the research studies done ncbi.nlm.nih.gov/pmc/articl...

The odds were better than I'd expected.

From what else I read, with a good experienced, specialist surgeon, return in the same location is unusual. Some surgeons are more conservative around excision on the bowel though, deeming endo remnants a lesser risk than the risk of a resection, its an area where there isn't consensus on the best approach so a detailed discussion with your surgeon on your preference is key. The pathological mechanism that is causing the implants is of course unaddressed by surgery so new endo can implant and grow elsewhere.